17-1723.3

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HAWAII ADMINISTRATIVE RULES
TITLE 17
DEPARTMENT OF HUMAN SERVICES
SUBTITLE 12
MED-QUEST DIVISION
CHAPTER 1723.3
MEDICAL ASSISTANCE FOR REPATRIATES
Subchapter 1 	General Provisions
§17-1723.3-1 	Purpose
§§17-1723.3-2 to 17-1723.3-6 	(Reserved)
Subchapter 2 	Eligibility Requirements
§17-1723.3-7 	Purpose
8§17-1723.3-8 	Eligibility requirements
§§17-1723.3-9 to 17-1723.3-13 	(Reserved)
Subchapter 3 	Benefits, Termination and
Repayment
§17-1723.3-14 	Purpose
§17-1723.3-15 	Benefits
§17-1723.3-16 	Termination of assistance
§17-1723.3-17 	Repayment
§§17-1723.3-18 to 17-1723.3-22 	(Reserved)
SUBCHAPTER 1
GENERAL PROVISIONS

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§17-1723.3-1 	Purpose. 	This chapter describes
the temporary medical assistance provided by the
department on behalf of the U.S. Department of Health
and Human Services (HHS) to a United States citizen or
national, or the dependent of a United States citizen,
who has been returned from a foreign country under the
provisions of the U.S. Repatriate program, as
established by Section 1113 of the Social Security
Act, 42 U.S.C. Section 1313, and as administered by
HHS through the International Social Service-United
States of America Branch (ISS-USA).
[Eff 	09/30/13] 	(Auth: HRS §346-14; 45 C.F.R.
§§211,212) (Imp: HRS §346-14; 45 C.F.R. §§211,212)
§§17-1723.3-2 to 17-1723.3-6 	(Reserved).
SUBCHAPTER 2
ELIGIBILITY REQUIREMENTS
§17-1723.3-7 	Purpose. 	This subchapter describes
the eligibility requirements for temporary medical
assistance under the U.S. Repatriate program.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 45 C.F.R
§§211,212) (Imp: HRS §346-14, 45 C.F.R §§211,212)
§17-1723.3-8 	Eligibility requirements. 	(a) 	An
individual eligible to receive repatriate medical
assistance shall meet the following requirements:
(1) 	A citizen of the United States or a
dependent of a citizen of the United States.
(2) 	Identified as having returned or returning
from a foreign country to the United States
through a written statement transmitted to
the department by an authorized official of
the Department of State (DOS) because of one
of the following reasons:
(A) 	Destitution;
(B) 	Illness of the individual or dependent;
(C) 	War;

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(D) 	Threat of war;
(E) 	Invasion; or
(F) 	Similar crisis.
(3) 	Without resources immediately accessible to
meet the individual’s needs.
(b) 	A mentally ill individual eligible to
receive repatriate medical assistance shall be:
(1) 	A U.S. citizen or U.S. national status;
(2) 	Verified with a certificate from an
authorized official of DOS or an appropriate
authority (as determined by HHS) from the
country of origin, that the individual has
been legally declared insane in that foreign
country or a certificate stating from such
appropriate authority that the individual
was in a named foreign country and was in
need of care and treatment in a mental
hospital; and
(3) 	Identified as having returned or returning
from a foreign country to the United States
due to certified mental illness through a
written statement transmitted to the
department by an authorized official of DOS.
(c) 	Individuals determined eligible for
repatriate medical assistance by DOS who are
subsequently determined eligible by the department for
Medicaid will receive medical assistance under the
state Medicaid program and not pursuant to this
chapter. 	[Eff 	09/30/13] 	(Auth: HRS §346-14; 45
C.F.R. §§211,212) (Imp: HRS §346-14; 45 C.F.R.
§§211,212)
§§17-1723.3-9 to 17-1723.3-13 	(Reserved).
SUBCHAPTER 3
BENEFITS, TERMINATION AND REPAYMENT
§17-1723.3-14 	Purpose. 	This subchapter
describes the benefit, termination and repayment

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provisions regarding temporary medical assistance
under the U.S. Repatriate program.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 45 C.F.R
§§211,212) (Imp: HRS §346-14, 45 C.F.R §§211,212)
§17-1723.3-15 	Benefits. 	(a) 	Benefits for an
individual eligible under this chapter shall be time-
limited for up to ninety (90) days from the date of
arrival in the United States unless the provisions of
(b) apply.
(b) 	With prior authorization from the HHS,
temporary medical assistance may be extended for up to
nine (9) months if the individual is unable to attain
self-support or self care due to age, disability or
lack of vocational preparation.
(c) 	Depending upon the circumstances of the
individual, and in consultation with the ISS-USA case
manager, an individual eligible for repatriate medical
assistance will be provided medical assistance either
as fee-for-service or enrolled in a health plan.
(d) 	The level of benefits provided to
individuals under the repatriate program shall be the
same as that provided under § 17-1737 for fee-for-
service or § 17-1720.1 for participating health plans.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§430.25, 431.40, 438.6, 45 C.F.R. §§211.6, 212.4,
212.5) (Imp: 	HRS §346-14; 42 C.F.R. §§430.25, 431.40,
438.6, 45 C.F.R. §§211.6, 212.4, 212.5)
§17-1723.3-16 	Termination of assistance. 	(a)
During the ninety (90) day repatriation period, the
department shall review as appropriate changes in an
individual’s situation to determine whether a
different plan of assistance is appropriate or the
individual is eligible for another medical assistance
program.
(b) 	Repatriate medical assistance shall be
terminated when the first of the following conditions
is met:

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(1) 	The individual has been determined eligible
for assistance under the state’s Medicaid
program;
(2) 	The individual has sufficient resources to
meet his or her needs; or
(3) 	On the ninety-first (91st) day from the date
of arrival, unless assistance has been
extended by HHS as provided in section 17-
1723.3-15(b).
(c) 	When repatriate medical assistance is
terminated the department shall assist the individual
in assessing eligibility for medical assistance under
other state or federal programs. 	[Eff 	09/30/13]
(Auth: 	HRS §346-14; 42 C.F.R. §§431.200, 431.213,
431.220, 435.912; 45 C.F.R. §§211.4, 211.6, 212.5,
212.6) (Imp: 	HRS §346-14; 42 C.F.R. §§431.200,
431.213, 431.220, 435.912; 45 C.F.R. §§211.4, 211.6,
212.5, 212.6)
§17-1723.3-17 	Repayment. 	(a) Temporary medical
assistance to eligible individuals under the
repatriate program is provided on a loan basis from
HHS and is not retroactive.
(b) Eligible individuals will be required to sign
the Privacy Act Statement and Repayment Agreement,
AFC-120, upon arrival in the United States.
(c) Assistance provided without a signed
repayment agreement in cases of medical emergency
conditions or unaccompanied minors remains on a loan
basis.
(d) The department is not responsible for the
repayment process of repatriate loans or any
collection, compromise or waiver of repayment.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 45 C.F.R
§§211.13, 212.7) (Imp: HRS §346-14, 45 C.F.R §§211.13,
212.7)
§§17-1723.3-18 to 17-1723.3-22 	(Reserved).